Dáil debates

Thursday, 17 May 2018

Topical Issue Debate

Mental Health Services Staff

4:45 pm

Photo of James BrowneJames Browne (Wexford, Fianna Fail)
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I welcome the opportunity to raise the issue of unqualified non-specialist doctors working as consultants in our mental health services. The President of the High Court, Mr. Justice Peter Kelly, has been extremely critical of this practice. He has described as scandalous the HSE practice of permitting non-specialist doctors to be appointed as consultants in hospitals and mental health services. He said that the HSE appears to be a law unto itself in this regard. These comments came from the President of the High Court. He also highlighted the disparity and distribution of sub-standard consultants, which is considerably higher in one CHO area and in regional hospitals. All 20 acute hospitals are affected. Mr. Justice Kelly was so perturbed that he directed that his judgment be sent to the Attorney General, the Minister for Health, the Secretary General of the Department of Health, the HSE chief executive, HIQA and the State Claims Agency. He made these worrisome criticisms in a decision to cancel the registration of an individual consultant who had made a series of medical errors.

The Medical Council, HIQA and the Irish Hospital Consultants Association are all reported as having expressed serious concerns about this practice. The College of Psychiatrists of Ireland recently stated that it holds that a doctor should not be a consultant if the doctor is not a specialist in the appropriate area of medical practice, yet unqualified doctors are being appointed as psychiatric consultants. These doctors have not undergone higher training, only basic training. They are not subject to the usual rules and oversight to which a qualified psychiatrist consultant is subject. They are not trained in leadership or management, but they are being paid the consultant rate. Indeed, if they are working for an agency, they may even be paid more. One week such a doctor may be a junior trainee and the next week he or she may be running the place. One week the senior registrar may be holding the hand of such a trainee and the next week the trainee may be giving senior registrar orders.

Let us consider for a moment what this means for patients. It means that someone who is not qualified is making orders to the effect that a person should be deprived of liberty or detained under the Mental Health Act against his or her will. Surely, this is a clear breach of human rights. It means that doctors are prescribing mediations and courses of treatment without the appropriate training, continuous upskilling or oversight. It means patient safety is being seriously compromised.

One of the regular excuses is that there is a shortage of consultants, but only some weeks ago the College of Psychiatrists of Ireland stated that it had enough quality candidates to increase the number of training places by at least 10%. Inexplicably, the HSE only approved a 5% increase in training places. Nothing adds up in this regard. It is clear that the practice of permitting non-specialist doctors to be appointed as consultants places the lives, health and welfare of patients at risk. This is a real patient safety issue. It is another example of the dysfunctionality at the heart of the HSE and it demands to be addressed immediately.

Will the scandalous practice of permitting non-specialist doctors from being appointed as consultants stop? Are people who have been the subject of medical errors by non-qualified consultants notified of these errors? Will the Minister undertake to increase the number of training places for those who actually want to be properly trained and who wish to properly qualify as psychiatric consultants?

Photo of Catherine ByrneCatherine Byrne (Dublin South Central, Fine Gael)
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I thank Deputy Browne for raising this important matter. Unfortunately, the Minister of State with responsibility for this area, Deputy Daly, is not here but has asked me to address the matter on his behalf.

Mental health policy, including policies and services for the prevention of suicide, remains a priority for Government. This is reflected by the additional funding of €35 million provided in the last budget, bringing total HSE funding for mental health to in excess of €910 million this year. A Programme for a Partnership Government gives a clear commitment to increase mental health funding annually, as resources allow, to expand and modernise all aspects of services. The HSE currently employs 324 whole-time-equivalent consultant psychiatrists to support community and specialist mental health services throughout the country.

There are 26 non-specialist consultant psychiatrists working in the Health Service Executive. The majority of these appointments are temporary, pending posts being filled permanently with a specialist consultant psychiatrist. These consultants carry out their work in the context of relevant HSE consultant contracts.

The HSE has advised that since 2008, it has worked to recruit only consultant psychiatrists in the public health system with appropriate specialist training and competence to enable individual consultants to attain and maintain specialist registration with the Irish Medical Council. The stated aim of the executive is to employ consultant psychiatrists with the highest possible level of training and expertise.

In March 2008, the HSE amended the qualifications specified for consultant posts in the public health service to require registration in the relevant specialist division of the register of medical practitioners at the Medical Council. The rationale for the change was to ensure that consultants employed in the public health system have the appropriate training, skills, competences and qualifications to deliver care as assessed by the Medical Council.

Internationally, there is a shortage of medical doctors, including appropriately trained consultant psychiatrists. Many countries in Europe and across the world are significantly challenged to recruit adequate levels of appropriately trained doctors.

In recent years, the HSE has developed new services, as outlined in the national mental health policy, A Vision for Change. This requires increased numbers of specialist trained consultants. In the context of staff recruitment and retention challenges set against the expansion of consultant posts throughout the country, individual consultant posts are sometimes filled temporarily with consultants who may not be entered into the specialist registration of the Irish Medical Council. This occurs in circumstances where, following exhaustive searches, no specialist consultant has been available. It is done to ensure ongoing delivery and continuity of essential mental health services.

The majority of consultant psychiatrist recruitment challenges are experienced outside the large urban centres. A particular and acknowledged recruitment problem relates to staffing for the child and adolescent mental health service, CAMHS, which the HSE is addressing on a priority basis. It should be noted that strategic priorities for mental health in the agreed HSE service plan 2018 include delivering a timely, "clinically effective and standardised safe service" together with developing highly trained staff within a modern infrastructure. The HSE mental health service is working closely with the HSE national doctors training and planning office and College of Psychiatrists of Ireland to increase the number of specialist training posts for psychiatrists. The intention is to create a larger potential pool of specialist consultants who can be trained in Ireland.

4:55 pm

Photo of James BrowneJames Browne (Wexford, Fianna Fail)
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While I appreciate that the Minister of State, Deputy Jim Daly, could not attend this discussion, the appointment of non-qualified medical personnel as consultants is a matter for the Minister for Health, Deputy Simon Harris, notwithstanding that the focus of the discussion is on psychiatric consultants. The dangerous practice I have highlighted has been described as scandalous by the President of the High Court who has written to as many of the relevant stakeholders as possible about the matter. Patients are not being informed that some of the consultants attending to them are unqualified. Some non-qualified consultants are being struck off the medical register because of medical errors. Are patients being notified of these medical errors, as is their entitlement?

There is a perverse incentive built into the current system. A trainee psychiatrist faces two choices. First, he or she can choose to spend three or four years doing higher training on a lower salary and trying to make his or her way through the proper channels. He or she also has the option to skip this step, however, and go straight into a senior position with a higher salary and the status that comes with a consultant role. If he or she can hold this position for three years, the post will almost certainly be made permanent, which means a specialist role in psychiatry will be permanently filled by someone who is not qualified. In such circumstances, it is the patients who lose out.

This is a serious matter. The words of the President of the High Court did not receive the attention they deserve because other very serious matters have arisen in health in recent weeks. People are becoming more aware that they are being treated by unqualified consultants. This matter will not go away as and must be addressed as a matter of urgency.

Photo of Catherine ByrneCatherine Byrne (Dublin South Central, Fine Gael)
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I do not have anything to add to Deputy Browne's contribution. I took a note of his concern that some of the consultants in situare not suitably qualified and I will convey his concern to the Minister of State, Deputy Daly, and the senior Minister. I will also inform them of the concerns the Deputy raised regarding matters that have arisen in recent weeks in the area of smear testing. I hope the Minister or Minister of State will respond to the Deputy on the issue.

Photo of Eugene MurphyEugene Murphy (Roscommon-Galway, Fianna Fail)
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I thank the Deputies and Ministers who contributed. We will suspend for a few moments to allow the Tánaiste and Minister for Foreign Affairs and Trade time to arrive for the Second Stage debate on the European Communities (Brexit) Bill 2017.

Sitting suspended at 5.37 p.m. and resumed at 5.42 p.m.